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Marjolin Ulcer

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Q) 35 year old male has come with Marjolin ulcer if the leg. True about Marjolin's ulcer is ?

a) Lymphatic spread is common

b) They are painful

c) Aggressive and fast growing tumors

d) Squamous cell carcinoma is the most common type

d. squamous cell carcinoma

When a SCC or BCC occurs in a long standing scar, it is called marjolin's ulcer.

Marjolin's type of ulcer is a malignant change that can occur in any long standing ulcer (ie venous ulcer)

Scar tissue is devoid of lymphatics, so no lymphatic spread. Lymphatic spread can still occur when it invades normal tissue. also nerve endings are not in scar tissue, so pain is a late feature

They are slow growing tumors but have propensity for distal metastasis  and squamous cell carcinoma is the most common type. Slow growth is again due to avascular characteristic

Bailey 28th 625

Contrast hazards in radiology

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Q1. Not true about hazards of contrast medium use in radiological interventions?

a) Use of newer agents have improved the risk of sudden death

b) Low osmolar contrast agents are better than previously used high contrast medium

c) After contrast injections, patients should be observed for 30 mins

d) Metformin can be continued in patients with normal renal function
Answer 1

Squamous cell cancer of upper esophagus

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Q) A 65-year-old male presents with grade IV dysphagia and is diagnosed with squamous cell carcinoma of the upper third of the esophagus. What is the most appropriate next step in management?

a) Definitive chemoradiotherapy
b) Neoadjuvant chemotherapy followed by transhiatal esophagectomy
c) Systemic chemotherapy alone
d) Neoadjuvant chemoradiotherapy followed by three-field esophagectomy

✅ Correct answer: a) Definitive chemoradiotherapy

💡 Explanation:

  • Upper third esophageal squamous cell carcinoma poses a challenge for surgical resection due to its proximity to the pharynx and larynx.

  • In resectable upper esophageal SCC, especially in older patients or when the tumor is very proximal, definitive chemoradiotherapy (CRT) is often the preferred treatment to avoid morbid surgery like laryngopharyngoesophagectomy.

  • Multiple guidelines, including NCCN and ESMO, recommend definitive CRT for upper esophageal SCC unless there’s a compelling reason for surgery.

❌ Why other options are incorrect:

  • b) Neoadjuvant chemo + THE:
      THE (transhiatal esophagectomy) is not suitable for upper esophageal tumors. It doesn't provide good access to cervical/upper thoracic esophagus.

  • c) Chemotherapy alone:
      Not standard. Chemotherapy without radiation is inadequate for curative intent in localized esophageal cancer.

  • d) Neoadjuvant CRT + three-field esophagectomy:
      Though this is an option for mid/lower third esophageal cancers, especially in younger patients, it's more morbid and rarely used for upper third SCC in older patients.

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Radical Cholecystectomy

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 Q) Radical cholecystectomy includes all except

a) Segment IVb and Va

b) 2cm wedge resection

c) Rt Extended Hepatectomy

d) Paraaortic lymphnodes

Answer and Explanation here

History of Radical Cholecystectomy

  1. Early 20th century removal of gall bladder and wedge of liver ( No lymphadenectomy) 
  2. In 1954, Glenn et al - radical resection procedure with intended regional lymphadenectomy (portal lymph node dissection), designated as “radical cholecystectomy” (Glenn operation)
  3.  Fahim et al in 1962 advocated radical resection consisting of hepatectomy and portal lymph node dissection

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Borderline resectable pancreatic malignancy

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Q)False in Borderline resectable Pancreatic malignancy

a) Solid tumor contact with the IVC <180

b) Solid tumor contact with the SMA of ≤180 degree

c) Solid tumor with CHA involvement of 2.5 CM

d) Solid tumor contact with the SMV or PV of >180 degrees

 

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Blood transfusion

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Surgery MCQ | mcqsurgery.com
Q81) In trauma what is the ratio of PRBC: FFP to be transfused?
a) 1:1
b) 1:2
c) 1:3
d) 1:4
Correct Answer: a) 1:1

When there is requirement of more than 6 units of PRBC, FFP and other blood products are required. FFP and platelets should be transfused first and then PRBC. For every 7–12 Units of PRBC, ideally 6 units of FFP and one unit of platelets should be given.
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Benign polyps of esophagus

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Q ) False regarding Benign lesion of esophagus

a) Fibrovascular  polyps are seen in mid and lower two third

b) Leiomyoma  and Leiomyosarcoma have same distribution.

c)Leiomyoma enucleation is sufficient

d) Leiomyoma are the most common benign tumors of esophagus

Ans- 

 

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Pouchitis after IPAA in ulcerative colitis

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NEET SS - Pouchitis Question

Free Question: NEET SS Surgery

Q: Which of the following is NOT a risk factor for pouchitis post-IPAA in ulcerative colitis?

Explanation Ans A :
Pouchitis is a common complication of Ileal Pouch Anal Anastomosis (IPAA) for Ulcerative Colitis, with an incidence up to 50%.

✅ Smoking is protective against pouchitis.

Risk factors include: - Extra-intestinal manifestations (e.g. arthritis) - ANCA positivity - NOD2insC mutation - NSAIDs and PPI use post-op - Extent of colitis and thrombocytosis

🔗 Ref: Wiley Journal Article